It consumed her entire life, the priest's hand on her body creating
a permanent tattoo that penetrated deeply into her soul.

She couldn't concentrate on her work, and her business regularly
faltered. Her sleep fragmented routinely under the weight of her
nightmares. Memories of being sexually abused by a revered member
of the local clergy haunted her, and they formed barriers between
her and the church doorway, between her and relationships with men.

She developed headaches, muscle pains, stomach distress and chest
pressure that defied repeated diagnostic divinations for physical
causes. Well into her 40s, she felt that her life had been stolen
from her decades earlier by the popular priest who repeatedly violated
her young body.

The woman who told me this story is but one of thousands of adults
living with the trauma of childhood sexual abuse suffered at the
hands of Catholic clergymen in the United States. Two studies reported
in the Washington Post on February 26 indicated that this current
epidemic of child sexual abuse has involved at least 4 percent of
all Roman Catholic priests who, between 1950 and 2002, allegedly
victimized 10,667 children. And although already alarming, these
numbers are considered to be underestimates because they depended
upon self-reporting by American bishops.

Like many other victims of this pedophilia scandal, this woman
bore her trauma in silence, unconsciously forcing her body to express
the suffering she could not voice. The shroud of silence that characteristically
drapes over this traumatic experience is a complex weave, but a
central thread is the tendency of these victims to blame themselves.
Victims often bear the stigma of shame, and they fear being rebuked
and discredited if they dare to criticize priests for ungodly acts.

The health care system often fails these victims as well. Despite
multiple presentations to the medical establishment with undiagnosable
conditions, this woman never divulged her history of abuse with
a doctor. No health care professional had inquired about that possibility
until a gynecologic nurse practitioner presented her with a standard
questionnaire soliciting Information about prior sexual trauma.

This deplorable pedophilia scandal should remind us all about the
devastating long-term consequences of childhood sexual abuse in
general. It should rouse in us a compassionate awareness about the
myriad difficulties that its victims may experience. As the American
College of Obstetrics and Gynecology points out, adults with histories
of sexual abuse often manifest a host of psychological, behavioral,
and physical symptoms. Physical complaints commonly include chronic
pain syndromes, various gastrointestinal or musculoskeletal symptoms,
sleep and eating disorders, and sexual dysfunction. Prevalent psychological
and behavioral dysfunctions include depression, anxiety, sexual
dysfunction, self-injury and dissociative states.

In the medical setting, I would argue in favor of all patients
being queried about any prior sexual abuse and trauma. If we limit
our screening only to people with symptoms that defy medical diagnosis,
we will miss a great number of opportunities to identify victims
of abuse who might benefit from therapeutic interventions. In fact,
a study published in 1993 in the Journal of the American Board of
Family Practice revealed that, when proactively screened, about
40 percent of women in a primary care setting reported having experienced
some form of childhood sexual contact, and 1 in 6 of those women
had been raped as a child.

Counseling and psychotherapy can prove to be a godsend for adult
survivors of childhood sexual trauma according to Rosemary Ehat,
a psychotherapist in Berkeley with an interest in the victims of
sexual abuse by Catholic priests. She reports that such survivors
typically feel shame, guilt, self-loathing, and depression. She
says that "rather than realizing that the shame belongs to
the perpetrator, the survivor feels bad and somehow tainted. Consequently,
some wait 10, 20, or even 50 years before breaking the chains of
silence that kept them locked in isolation."

In addition to the physical and psychological expressions of their
abuse, "these people also lose their religious and spiritual
home" and "they go on with their lives but feel burdened
by the secret and the feelings of betrayal and abandonment."

She also suggests that a healing and supportive environment may
be found through participation in support groups like SNAP.

The alarming magnitude of childhood sexual abuse by Catholic priests
as revealed in the new studies and the known high prevalence of
abuse within the general public recommend that we vigorously speak
out against this appalling and widespread crime. That we lend our
voices to the victims, to help them break the silence that insulates
them from opportunities for healing. That as health care workers
we assume a proactive stance in remaining mindful of the ways that
their suffering can be expressed, physically and psychologically.

As Ms. Ehat reminds us, "Lifting the veil of secrecy and cover-ups
is the first step in bringing about both private and communal healing.

Kate Scannell practices medicine with Kaiser Permanente and
authored the book, "Death of the Good Doctor."